Sexuality and Sex Hormones Flashcards
(28 cards)
Biological sex
Set of biological attributes
Gender identify/expression
Internal sense of gender
Societal roles, behaviours, expression
Sexual orientation
Sexual, romantic, physical attraction to others
3 main sex hormones
Testosterone
Di-hydrotestosterone
Estrogens
Klinefelter syndrome
47 XXY (phenotypic male)
Most common cause of low testosterone
May not be diagnosed until infertility work up
Semen analysis: azoospermia (lack of sperm)
This is primary hypogonadism
Signs and symptoms of low testosterone
Mild: decreased libido* (first thing to go), decreased vitality, fatigue, modd changes, insomnia
Moderate: anemia, delayed ejaculation, flushes, erectile dysfunction, decreased muscle mass, increased visceral body fat
Severe: testicular atrophy, weakness, osteopenia/porosis, loss of facial, axially and pubic hair
In men low testosterone generally leads to what 4 things
Loss of sexual desire
Loss of sleep associated erections
Delay in ejaculation and low volume ejaculate
Variable loss of sexual erections
What are some things that can cause secondary hypogonadism?
Brain tumour
Hemochromatosis
Opioids, corticosteroids, alcohol
HIV
In
1. Primary
2. Secondary
hypogonadism is LH/FSH going to be low or high
- High
2. Low or inappropriately normal
Benefits of replacing testosterone in younger men
Restores sexual function, bone density, and muscle power
Decreased upper abdominal obesity/insulin resistance
Improves metabolic parameters when type 2 DM or metabolic syndrome is comorbid
May decrease CV risks from low testosterone
Should testosterone be replaced in older men
Not sure - the evidence is missing Possible CV harm Benefit to anemia and bone density Some increase in sexual desire, sexual frequency and mood No effect on cognition or energy
Contraindications to testosterone replacement (6)
PSA > 4 nM Abnormal prostate on DRE HCT > 50% Untreated obstructive sleep apnea Severe cardiac failure Breast or prostate cancer
Risks of pharmacological doses of testosterone
CV: SCD, thrombogenesis
Liver cancer
Psych: mood swings, aggression, paranoia, anxiety, roid rage
Infertility, small testes, gynecomastia, acne
3 times we intentionally suppress T
Androgen deprivation therapy for prostate cancer
Treatment of severe paraphilias
Trans male to female hormone therapy
2 ways to suppress T
LH releasing hormone agonists and antagonists
Anti-androgens/androgen blockers
Expected changes for hormone replacement therapy when transitioning from male to female
Breast development and body fat redistribution
Decreased muscle mass, body and facial hair
Decreased sexual desire and ED
Decreased fertility
Decreased testicular size
Emotional changes
Intersex
Born with sexual anatomy that doesn’t fit the typical definitions of female or male
Born with female external genitalia, but having mostly male-typical internal genitalia
Born with genitals that seem to be in-between the usual
Complete androgen insensitivity
X-linked recessive
Y chromosome means you make testosterone, but cannot respond to it
Androgen receptor gene mutations
Female typical external genitalia
Absent vagina or short vagina with blind end
Testes in abdomen, inguinal canals, or labia majora
Normal female breast development
Absent pubic hair
No spermatogenesis
Testosterone levels normal or increased (in XY reference range)
Partial androgen insensitivity
Less common than CAIS
Spectrum extends from phenotypic women (with breasts) and partial virilization of external genitalia with clitoromegal to phenotypic males with variable defects in genital virilization and may also have other signs
What hormone is responsible for masculinization
- In utero
- At puberty
- DHT
2. Testosterone
5-alpha reductase deficiency
Born with ambiguous genitalia (large clit, separate scrotum, apparent vaginal opening)
Externally appear female
Internal sex organs are male
At puberty the increased testosterone causes masculinization (voice, penile growth, male body type)
Polycystic Ovarian Syndrome
High LH and testosterone
Most common endocrine disorder in premenopausal women
Can have hirsutism/acne/obesity
Congenital adrenal hyperplasia
High T in utero acting on brain and body
Effects of excessive androgen action in XX fetus
Autosomal recessive
Varying degrees of masculinization of genitalia in female fetuses, no visual abnormalities in male fetuses
Potentially fatal if cortisol and aldosterone severely reduced
Should you test for low testosterone in women?
No!
Questionable relevance of blood level
